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Iowa Department of Human Services FAX Completed Form To 1 (800) 5742515Request for Prior Authorization ()Provider Help Desk 1 (877) 7761567(PLEASE PRINT ACCURACY IS IMPORTANT) IA Medicaid Member ID
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To fill out the PA Form NPI Jan, follow these steps:
02
Start by entering your personal information, such as name, address, and contact details.
03
Provide your National Provider Identifier (NPI) number, if applicable.
04
Indicate the reason for submitting the form and provide any supporting documentation if required.
05
Fill out the specific sections according to the instructions provided on the form.
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Who needs pa form npi jan?

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Anyone who is required to provide their National Provider Identifier (NPI) information or complete the PA Form NPI Jan needs to fill out this form. This may include healthcare professionals, medical providers, or entities involved in healthcare services.
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PA Form NPI JAN is a state-specific tax form used for reporting certain financial information, particularly related to medical providers' national provider identification numbers.
Individuals or entities that provide medical services and are registered as healthcare providers in Pennsylvania are required to file PA Form NPI JAN.
To fill out PA Form NPI JAN, gather your national provider ID and any necessary financial documents. Complete the sections detailing your identification number and other relevant information, then submit the form to the appropriate department.
The purpose of PA Form NPI JAN is to collect and verify the national provider identification numbers of medical providers for regulatory and billing purposes.
The form requires reporting your national provider identification (NPI) number, personal identification information, and possibly a summary of services rendered if applicable.
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